Esophageal motility disorders encompass a group of conditions in which a portion of the esophagus contracts or functions improperly. During normal swallowing, significant coordination of muscle and neurologic impulses is required to transport food from the esophagus to the stomach. When this process is disrupted, an individual can experience difficulty swallowing solids or liquids, chest pain, regurgitation, or a food sticking sensation. Achalasia is the most common esophageal motility disorder that is treated surgically

Types of Esophageal Motility Disorders

The esophagus is a muscular tube that contracts rhythmically to move food from the mouth, through the upper esophageal sphincter, down to the lower esophageal sphincter and into the stomach. The vast majority of patients with an esophageal motility disorder suffer from achalasia, in which abnormal contraction or incomplete relaxation of the lower esophageal sphincter impedes flow of food from the esophagus to the stomach.

It is much less common for an esophageal motility disorder to affect the upper sphincter directly. When this does occur, it is typically due to an abnormally tight and high contraction that causes chest pain and difficulty swallowing.

Diagnosing an Esophageal Motility Disorder

Treatment for an esophageal motility disorder depends on the underlying cause of the condition. Therefore, it is important that an experienced thoracic surgeon perform a comprehensive work up to determine an appropriate course of treatment. Diagnostic tests used to examine the internal anatomy and function of the esophagus include:

Esophageal manometry

Barium esophagram

Upper endoscopy (EGD)

Treatment of Achalasia

The goal of treatment for achalasia is to permanently loosen the lower esophageal sphincter to improve flow of food contents and alleviate symptoms. While calcium channel blockers and other medications which relax smooth muscle have been attempted, the results have been disappointing. Endoscopic techniques, including Botox injections, have also been tried but require frequent repeat treatments. The predominant and most effective form of treatment for achalasia is minimally invasive surgery.

Heller Myotomy is a thoracoscopic (minimally invasive) surgical procedure that involves cutting the outer and inner layers of muscles of the lower esophageal sphincter. This permanently relaxes the sphincter and greatly reduces the discomforting symptoms associated with achalasia. To prevent future acid reflux, Heller myotomy may be coupled with a partial fundoplication (reflux surgery).

Contact an Expert Thoracic Surgeon

Ali Mahtabifard, MD and Clark Fuller, MD, directors of West Coast Thoracic Surgery, are renowned thoracic surgeons specializing in the treatment of numerous benign diseases and malignancies within the chest cavity. Our surgeons are experienced in the most advanced minimally invasive techniques available to safely and effectively treat a variety of esophageal diseases, including esophageal motility disorders.

To learn more about treatment for achalasia or another esophageal motility disorder, or to schedule a consultation with one of our expert thoracic surgeons, please call 310.854.0909 or fill out our online contact form.